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—I thank Dr Shin and colleagues for their kind and thoughtful comments. They cite references that demonstrate that the aqueous humor concentration of ascorbate increases with age in rabbits and that aqueous humor ascorbate concentrations are decreased in cases of neovascular glaucoma. It would be interesting to confirm these observations in a large number of patients and determine if aqueous humor ascorbate levels correlate with successful glaucoma surgery.A great deal of attention has been given to improving the success rate of glaucoma surgery pharmacologically. Less emphasis has been given to understanding why the operation usually does work, given that most other surgical wounds heal completely. Shin et al correctly remind us that the reason glaucoma filtration surgery succeeds remains a mystery. Aqueous humor composition may be one of numerous determinants of the operation's success or failure, and clearly it merits further investigation.
Jampel HD. Ascorbic Acid Is Cytotoxic to Dividing Human Tenon's Capsule Fibroblasts: A Possible Contributing Factor in Glaucoma Filtration Surgery Success-Reply. Arch Ophthalmol. 1991;109(3):319. doi:10.1001/archopht.1991.01080030020013
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